左西孟旦治疗扩张型心肌病患者的短期疗效分析和安全性观察

Short-term efficacy and safety observation of Levosimendan in treatment of patients with dilated cardiomyopathy

目的探讨和分析在临床中应用左西孟旦治疗扩张型心肌病(DCM)合并急性失代偿性心力衰竭(ADHF)患者的短期效果及安全性。方法选择2018年7月—2022年7月安徽医科大学第二附属医院收治的100例DCM合并ADHF患者作为研究对象,根据药物治疗过程中是否应用左西孟旦分为对照组(常规药物治疗)和观察组(联合应用左西孟旦),每组50例。收集两组患者入院时和治疗1周后左室射血分数(LVEF)、左室舒张期末内径(LVEDD)、N末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白I(cTnI)水平及心功能分级,评价药物治疗的有效性。结果两组患者在经过临床药物治疗后LVEF水平均有不同程度的提升[对照组(%):35.00(27.75,40.25)比32.00(26.00,36.00),观察组(%):35.00(31.15,40.00)比31.75(26.75,36.00)],LVEDD均减小[对照组(mm):64.00(60.00,72.25)比66.50(62.00,74.00),观察组(mm):64.00(58.00,72.25)比66.50(60.00,75.25)],NT-proBNP和cTnI均下降[对照组NT-proBNP(ng/L):1357.50(829.00,3500.00)比4237.50(1929.75,7359.25),观察组NT-proBNP(ng/L):1891.50(1091.25,3986.75)比7198.00(3120.50,13752.50),对照组c TnI(μg/L):0.01(0.01,0.01)比0.02(0.01,0.04),观察组cTnI(μg/L):0.02(0.01,0.03)比0.03(0.02,0.06)],差异均有统计学意义(均P<0.05)。两组治疗后比较,观察组患者LVEF、LVEDD、NT-proBNP水平变化幅度均优于对照组,两组间的差异存在统计学价值(均P<0.05);而两组患者cTnI水平变化趋势的差异不存在统计学价值(P>0.05)。两组患者比较,治疗后观察组临床有效率较对照组上升[80.0%(40/50)比76.0%(38/50)],无效率下降[20.0%(10/50)比24.0%(12/50)],差异不存在统计学价值(P>0.05)。治疗期间两组均未出现明显不良反应。结论在临床中治疗DCM合并ADHF患者时通过常规药物和左西孟旦联合应用方式能够改善心功能指标,且安全有效。

Objective To study and analyze the short-term clinical effects and the safety observation of patients with dilated cardiomyopathy(DCM)and acute decompensated heart failure(ADHF).Methods From July 2018 to July 2022,100 patients with DCM and ADHF in the Second Hospital of Anhui Medical University were selected as the research objects.According to whether or not Levosimendan was applied in the treatment,they were divided into the control group and the observational group,with 50 patients in each group.The two groups of patients’left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),N-terminal pro-brain natriuretic peptide(NT-proBNP),cardiac troponin I(cTnI)and heart functional grading were collected on admission and one week after treatment.The clinical effects of medicine treatment were evaluated.Results After the clinical treatment,there was significantly elevated in the level of LVEF in both groups compared with those before treatment[control group(%):35.00(27.75,40.25)vs.32.00(26.00,36.00),observational group(%):35.00(31.15,40.00)vs.31.75(26.75,36.00),both P<0.05].There was significant decrease in the level of LVEDD in both groups compared with those before treatment[control group(%):64.00(60.00,72.25)vs.66.50(62.00,74.00),observational group(%):64.00(58.00,72.25)vs.66.50(60.00,75.25),both P<0.05].There was significant decrease in the levels of NT-proBNP and cTnI in both groups compared with those before treatment[control group NT-proBNP(ng/L):1357.50(829.00,3500.00)vs.4237.50(1929.75,7359.25),observational group NT-proBNP(ng/L):1891.50(1091.25,3986.75)vs.7198.00(3120.50,13752.50),control group cTnI(μg/L):0.01(0.01,0.01)vs.0.02(0.01,0.04),observational group cTnI(μg/L):0.02(0.01,0.03)vs.0.03(0.02,0.06),all P<0.05].After the treatment of Levosimendan,the magnitude of changes in LVEF,LVEDD and NT-proBNP of the patients in the observational group was better than that in the control group,and the difference between the two groups was significant(all P<0.05).However,there was no significant difference in cTnI between the two groups(P>0.05).Compared with the two groups of patients,the clinical effective percentage of the observational group increased[80.0%(40/50)vs.76.0%(38/50)],the clinical ineffective percentage decreased[20.0%(10/50)vs.24.0%(12/50)],but there was no significant difference(P>0.05).During the treatment stage,there was no obvious adverse symptoms in the two groups.Conclusions Administration of Levosimendan combined with routine medication for DCM patients with ADHF could significantly improve cardiac function parameters.The treatment of Levosimendan is effective and safe in DCM patients with ADHF.